Intimate Partner Violence in El Salvador: A Relationship Between Femicide Attempts and Barriers to Help-Seeking

Research has examined the relationship between femicides, understood as the killing of any woman, and intimate partner violence (IPV). Additionally, women have been found to seek out formal help when they deem their experiences to be severe, yet many reasons prevent them from doing so; hindering our ability to interrupt the cycle of violence and further victimization. Using the Salvadoran 2017 Violence Against Women National Survey, this study examines the relationships between femicide attempts, IPV, and formal help-seeking. We find a significant positive relationship between experiencing a femicide attempt and IPV, and specific reasons for not seeking formal help.

The Impact of Child Polyvictimization and Cultural Factors on Lifetime Intimate Partner Violence Among Salvadoran Women

This study examined the impact of child abuse on intimate partner violence (IPV) among a representative sample of 3,296 women using the Violence Against Women National Survey data from El Salvador. We found that child physical, sexual, and psychological abuse were independently associated with IPV, and experiencing child polyvictimization, along with having a controlling husband increased the risk of IPV victimization. To prevent child abuse (poly)victimization and IPV, and its negative consequences in El Salvador, implementing programs that focus on group training for women and men, as well as, community mobilizations that involve multiple stakeholders with multiple approaches would be beneficial.

The Effects of Polyvictimization by Intimate Partners on Suicidality Among Salvadoran Women

Intimate partner violence (IPV) victims tend to suffer from various mental health issues. Mental health issues, including suicidal thoughts and attempts caused by IPV victimization, might be more severe among women in El Salvador, where violence against women is prevalent overall. Although polyvictimization, which is defined as experiencing more than one type of violence by one or multiple partners, is associated with more severe mental health consequences than victimization by just a single form of violence due to accumulative trauma, not enough attention has been paid to this phenomenon among Salvadoran women. Thus, guided by trauma theory, this study aimed to examine the impact of polyvictimization from different types of violence (i.e., physical, sexual, emotional, and economic) on suicidal thoughts and attempts among Salvadoran women using the 2017 Violence Against Women National Survey. A nationally representative sample of 3,074 Salvadoran women aged 15 years or older and who had experienced an intimate relationship in their lifetime, recruited through a multistage random sampling design, was analyzed in this study using logistic regression analyses. We found that psychological and economic violence, along with physical and sexual violence, had statistically significant associations with suicidal thoughts and attempts, and polyvictimization increased suicidal thoughts and attempts. Based on this study's findings, we recommend effective research and practice or intervention implementation for addressing IPV and associated mental health problems among Salvadoran women.

Understanding Formal Responses to Intimate Partner Violence and Women's Resistance Processes: A Scoping Review

Intimate partner violence (IPV) literature addresses the ways in which women oppose violent male partners through acts of "everyday resistance." There is a limited understanding, however, of the relationship between women's resistance and their formal help-seeking in the context of IPV. Our scoping review, which includes 74 articles published in English-language journals between 1994 and 2017, attempts to help fill this gap by developing systematic knowledge regarding the following research questions: (1) How are formal institutional responses discussed within the literature on resistance to IPV? (2) How does institutional help-seeking facilitate or obstruct IPV survivors' personal efforts to resist violence? We find that institutions and organizations succeed in facilitating resistance processes when they counter victim-blaming ideas and provide IPV survivors with shared community and a sense of control over their futures. However, they fall short in terms of helping survivors by expecting survivors to adhere to a rigid narrative about appropriate responses to violence, devoting insufficient attention to individual-level factors impacting survivors' vulnerability and ability to access help, and replicating abuse dynamics when interacting with survivors. Policy and practice implications are discussed.

Understanding Women's Resistance to Intimate Partner Violence: A Scoping Review

Scholars widely acknowledge that women oppose male violence and control in intimate relationships. Yet there is limited comprehensive knowledge of how resistance features in intimate partner violence (IPV) research across the social sciences. Our scoping review helps fill this gap, analyzing and synthesizing 74 research articles published in English-language scholarly journals between 1994 and 2017. Our review is guided by the following questions: (1) How is research on IPV and resistance designed and executed? (2) How do IPV researchers define the term resistance? (3) What specific types of resistance do IPV researchers discuss in their work? (4) What policy and practice implications are provided by current literature on women's resistance to IPV? We find that scholarship on resistance to IPV is varied, spanning 10 scholarly disciplines with research samples drawn from 19 countries. Studies overwhelmingly used qualitative data, gathered through a range of techniques. The 42 articles that explicitly or implicitly defined resistance either conceptualized the term in the context of power relations, defined it as a form of agency, or understood resistance as a mechanism of physical, economic, and existential survival. Articles also identify several subtypes of resistance strategies including avoidance, help-seeking, active opposition, violent action, and leaving a violent relationship. In terms of practice and policy, articles identify several ways in which institutions fail to meet women's needs, and recommend training so providers and legal personnel may better assist IPV victims.

Understanding the Body and Embodiment in the Context of Women's Resistance to Intimate Partner Violence: A Scoping Review

Scholars acknowledge that women oppose male intimate partner violence (IPV). Yet there is limited comprehensive knowledge regarding how women's bodies and embodiment, that is, their physical and emotional practices and the cultural and social systems that influence them, figure in this process. Our scoping review helps fill this gap by analyzing and synthesizing 74 research articles published in English-language scholarly journals between 1994 and 2017 to address three research questions: (1) How does existing IPV research conceptualize resistance? (2) To what extent do the body and embodiment appear in this research? and (3) What common themes emerge from investigation of the role of embodiment and the body in the context of IPV? The articles identify several subtypes of resistance strategies including avoidance, help-seeking, violent action, and leaving a violent relationship. The reviewed research also regularly describes women's physical and emotional states in the context of IPV. Only a small number of these texts, however, define or conceptualize embodiment. Our analysis of the manner in which the body figures in women's resistance to IPV yielded four themes: (1) the active body, (2) the injured/constrained body, (3) the interactive body, and (4) the transformative body. We conclude with a discussion of policy and practice implications, such as the need to increase awareness about how institutions enforce embodied norms among victims and use the body to assign blame and/or proffer assistance in the context of IPV.

“Aren’t I a Victim?”

The mandated arrest of domestic violence perpetrators is a policy response to the problem of partner violence. Mandatory arrest can result, however, in unintended and sometimes undesirable arrest outcomes, including dual arrests (when both parties are arrested), retaliatory arrests (when the perpetrator has his or her partner wrongfully arrested), and failures to make an arrest (when one is warranted by law). Using an inter-actionist perspective, this research focuses on one negative effect of mandatory arrest: the identity challenge faced by female victims of domestic violence who experience undesirable arrest outcomes. The authors discuss policy implications, focusing on the potential empowerment effects of mandatory arrest.

Community violence, social support networks, ethnic group differences, and male perpetration of intimate partner violence

The authors examined how witnessing community violence influenced social support networks and how these networks were associated with male-to-female intimate partner violence (IPV) in ethnically diverse male college students. The authors assessed whether male social support members themselves had perpetrated IPV (male network violence) and whether female social support members had been victimized by intimates (female network victimization). The results indicated an association between community violence and male network violence; both factors were significantly associated with higher levels of IPV. Furthermore, the relationship between community violence and IPV was partially mediated by male network violence. Additionally, the results indicated a moderated relationship such that male participants who reported the highest levels of exposure to community violence and male network violence were at highest risk for IPV. However, this relationship did not hold across all ethnicities and races. The findings suggest that the mechanisms associating community violence, networks, and IPV are multifaceted and differ across ethnicity and race.

Harnessing the Power of Advocacy-Research Collaborations: Lessons From the Field

The advocacy-research partnership has been identified as a key method of conducting the feminist and activist research that is important to domestic violence. However, these partnerships are often fraught with challenges that may jeopardize their development, sustainability, and potential impact on policy. Previous commentators have identified key challenges to engaging in advocate-researcher collaborations. This article takes particular care to set forth an advocate perspective through the authors' experience of planning and executing a collaborative study on the effects of mandatory arrest. The authors use a study that was specifically designed to affect policy to offer insight into the challenges faced and to make recommendations for successfully incorporating social action in advocacy-researcher collaborations.

It doesn't happen here: eating disorders in an ethnically diverse sample of economically disadvantaged, urban college students

The bulk of eating disorder studies have focused on white, middle-upper class women, excluding ethnically and economically diverse women and men. Accordingly, our knowledge of prevalence rates and risk factors is reliant on this narrow literature. To expand upon the current literature, we examined eating disorders in ethnically diverse low-income, urban college students. We surveyed 884 incoming freshmen during an orientation class to assess the frequency of eating disorder diagnosis and the risk factors of child physical abuse and sexual abuse before and after age 13. We found 10% of our sample received an eating disorder diagnosis, 12.2% of the women and 7.3% of the men. The majority of these students were Latino/a or "other," with White women receiving the fewest diagnoses. For all women, both child physical abuse and both indices of sexual abuse contributed equally to the development of an eating disorder. For men only the sexual abuse indices contributed to an eating disorder diagnosis. These results indicate that ethnic minority populations do suffer from relatively high rates of self-reported eating disorders and that a history of trauma is a significant risk factor for eating disorders in these diverse populations of both women and men.

The relationship between drug abuse and sexual performance among women on methadone

PURPOSE

Through in-depth interviews with 38 women recruited from methadone maintenance treatment programs (MMTPs), this paper examines subjective experiences regarding the effects of illicit drugs on the women's sexual behavior and that of their male sexual partners, mainly changes in libido, performance, and pleasure.

METHODS

This paper addresses several questions: (1) How does drug use affect women's sexual performance? (2) How does drug use affect their partners' sexual performance and the sexual dynamics in their relationship? (3) How does drug use affect these women and their partners differently? (4) How are sexual disparities between women and their partners, heightened by drug use, linked with sexual and physical violence and risk of HIV?

RESULTS

Three major themes are discussed: some women believe that drugs, particularly heroin, increase their sexual performance, libido, and pleasure, but for others, drugs, particularly crack cocaine, inhibit their sexual performance and desire. Many of the women believe that crack cocaine and heroin enhance a man's sexual desire, performance, and pleasure. However, other women deem that these drugs are responsible for their partners' abusive and coercive behavior. The data further indicate that gender disparities, in how crack cocaine and heroin affect the sexual dynamics between drug-involved couples, often lead to sexual coercion and physical abuse.

CONCLUSION

This in-depth narrative study of abused women in MMTPs draws implications from their subjective experiences for understanding the contextual mechanisms linking drug use, intimate sexual abuse, and HIV risk. It also suggests implications for designing HIV prevention programs that take into account the differential effects of drugs on sexual intimate violence and HIV risk. Education about the effects of drugs on sexuality and on the risks of sexual violence and HIV transmission is crucial for drug-involved women.

Intimate partner sexual abuse among women on methadone

This article reports findings on the prevalence and correlates of intimate partner sexual abuse (using the Revised Conflict Tactics Scale) among a sample of women in methadone treatment in New York City. Results indicate that, during the course of the intimate relationship, approximately 15% of women had experienced intimate partner sexual assault and 47% were sexually assaulted and/or coerced. Nine percent had experienced intimate partner sexual assault and 38% intimate partner sexual coercion in the past year of the relationship. Bivariate analyses revealed that women who were sexually abused in the 12 months prior to the interview tended also to be physically abused by intimate partners. Women who were unemployed, poor, crack-cocaine or injecting-drug users, and were physically and/or sexually abused as children, were at increased risk of experiencing intimate partner sexual abuse in adulthood. In multivariate models, only extreme poverty and sexual abuse in childhood emerged as risk factors for intimate partner sexual abuse in adulthood.

Linking drug-related activities with experiences of partner violence: a focus group study of women in methadone treatment

This study examines various contexts in which drug-related activities may be linked with intimate partner violence among women in methadone treatment. We conducted 14 focus groups with 68 predominantly Latina and African American women, who reported recent partner abuse. Guided by Goldstein's tripartite model, gender theory, and trauma theory, our inquiry explored how partner violence may be related to psychopharmacological effects of drug use and to conflicts over procuring and splitting drugs. We also examined whether women used drugs to cope with the violence. Across the focus groups, women reported that their low social status and perceived sexual availability as "drug-using women," their partner's substance use, their own verbal aggression under the influence of crack and alcohol, and conflicts over procuring and splitting drugs played a role in their victimization. The findings further suggest that conflicts over gender role expectations interact with drug-related activities, increasing the likelihood of a violent outcome.

The converging epidemics of mood-altering-drug use, HIV, HCV, and partner violence: a conundrum for methadone maintenance treatment

BACKGROUND

Accumulating evidence suggests that partner violence may be associated with HIV risk behavior and drug use among women in methadone maintenance treatment programs (MMTPs), yet the mechanisms linking these overlapping problems remain unclear. The main purpose of this qualitative study is to explore in detail how drug-related activities and HIV risk behavior occur in the context of a recent episode of partner violence among women in MMTPs.

METHOD

We conducted and analyzed in-depth interviews with 31 women who reported having experienced physical or sexual violence by an intimate partner during the past year. Guided by existing research, feminist theory and trauma theory, we constructed a set of questions which were designed to explore multiple ways in which drug-related activities or HIV risk behavior may be linked directly or indirectly to the recent event. To examine the extent and significance of the woman sand/or her partner s drug-related activities or sexual HIV risk issues occurring immediately before, during and/or after the most recent event, we adapted a series of techniques for thematic analysis of qualitative data.

RESULTS

Of the 31 women who reported recent events: 83.8 % (n=26) recalled recent events in which there was some drug-involvement; 40% (n=13) indicated that both she and her partner were involved in drug-related activities during the most recent event of partner abuse; 35% (n=11) reported that the partner was drug-involved; and only two women (6.4%) indicated that they alone had been drug-involved. One-fifth (19.3%, n=6) of the women indicated that they had used drugs immediately after the event because they were upset or in physical pain. One-fifth of the women (n=6) reported that they had coerced, unprotected sex during or after the most recent incident.

CONCLUSIONS

The multiple ways in which the use of mood-altering drugs are related to partner violence and the occurrence of coerced, unprotected sex underscore the need to design specific interventions for preventing drug relapse, and HIV and HCV infection among abused women in MMTPs. Treatment and policy implications of study findings are discussed.

Fear and violence: raising the HIV stakes

Through focus group methodology, the study examines three contexts that delineate the co-occurrence of intimate partner violence and sexual risk behaviors among 68 women on methadone. First, it explores the ways in which the presence of physical abuse in an intimate relationship prevents women from asking their partners to use a condom. Second, it describes the ways in which the couple's drug involvement increases the risk of physical and sexual violence, and concomitant sexual HIV risks. Third, it discusses the context in which sexual assault and rape occur in these established intimate relationships and how these abusive events increase women's risks of becoming infected with HIV. The research is guided by feminist theory, which affords powerful insight into the contexts in which women are put at risk for HIV and partner violence. The study provides a discussion on the implications of the findings to HIV prevention for women who are risk for both HIV and partner violence.

Tonsillectomy and the value of peritonsillar infiltrations

In this prospective double-blind trial, the effect of peritonsillar infiltrations was assessed with regard to intra-operative bleeding and postoperative pain in 100 young adults who underwent elective tonsillectomy under balanced general anaesthesia. Patients were randomly assigned to 1 of 5 groups (20 patients in each group) and received infiltrations as follows: group 1--bupivacaine (0.5%) with adrenaline (1:200,000); group II--bupivacaine (0.5%); group III--normal saline with adrenaline (1:200,000); group IV--normal saline; group V--no infiltration (control group). With regard to blood loss, groups I-IV lost a mean of 47 ml (95% CI = 69.78), while group V lost a mean of 121 ml (95% CI = 78.10) (P = 0.0002). Group V had the highest pain score (average 4.62) measured in recovery, 4 and 24 hours after tonsillectomy (P = 0.0051) and required more narcotic analgesia. Groups II and III had the lowest score (average 1.72) after 24 hours. The bupivacaine group (II) had the highest incidence (71.4%) of nausea and vomiting. Peritonsillar infiltrations decrease intra-operative bleeding and pain, independent of the type of solution infiltrated, by providing a better defined plane of dissection which minimises trauma to the surrounding tissue. Normal saline infiltrations with or without adrenaline should be used since they have no side-effects and are inexpensive and easily available.

Continuous intra-arterial blood-gas monitoring in infants and children with cyanotic heart disease

We have evaluated the accuracy and reliability of the Paratrend 7 continuous blood-gas analyser in infants and small children under conditions of severe hypoxaemia admitted to the paediatric intensive care unit in the perioperative period with cyanotic congenital heart disease. PO2, PCO2 and pH (hydrogen ion concentration) were measured continuously via a femoral arterial sensor and compared with 100 simultaneous paired arterial blood-gas measurements. Data were analysed by Bland-Altman analysis for bias and precision. Sensors were placed in 10 children of median age 5.43 (range 0.03-45) months, median weight 3.74 (2.79-15.4) kg and remained in place for up to 27 h after operation. PO2 values were 2.5-8.2 kPa (median 5.3 kPa). Co-oximeter saturation ranged from 37.1% to 90.6% (median 75.8%). Bias and precision values were 0.04/0.87 kPa for PO2, -0.44/0.74 kPa for PCO2 and -2.61/6.98 nmol litre-1 for hydrogen ion concentration (i.e. 0.02/0.06 for pH). We conclude that perioperative continuous arterial gas monitoring is clinically accurate under conditions of severe hypoxaemia in small infants and children with cyanotic congenital heart disease.

A wooden orbital foreign body

A case is reported in which a patient presented, 18 months after initial injury, with a progressive proptosis of the left eye. X-rays did not reveal a foreign body but a fracture of the lateral orbital wall and an area of soft tissue density were seen on the CT scan. Exploration of the orbit revealed a 2 cm wooden fragment in the floor of the orbit.

Histoplasmosis of the oral cavity, oropharynx and larynx

A patient with oropharyngolaryngeal histoplasmosis is presented. He has been treated for disseminated tuberculosis (TB) for 10 months, with no improvement. Repeat biopsy of a tongue ulcer, together with a swab of the ulcer base, confirmed the presence of Histoplasma capsulatum. Treatment with amphotericin B resulted in a rapid recovery.

Tinnitus related to eyelid blinking

Tinnitus due to muscular causes is rare. The commonest pathological muscular cause of tinnitus is palatal myoclonus. A case of bilateral tinnitus, related to eyelid blinking, is presented. This is the first case reported in the literature. Previous reported cases of tinnitus related to eyelid blinking have all been unilateral and associated with recovery from a VII nerve palsy. The treatment of the condition is discussed.

Management of peritonsillar abscess

A prospective, randomized clinical trial was conducted on 60 patients with confirmed peritonsillar abscess to: (1) compare the safety and efficacy of permucosal needle aspiration with that of incision and drainage; (2) assess whether admission to hospital and treatment with intravenous antibiotics is necessary; (3) culture the pus obtained, in order to decide on a rational antibiotic regime. Of the 60 patients, 30 were randomized to the needle aspiration group, and 30 to the incision and drainage group. The initial success rate was 87 per cent (26 of 30 patients) with needle aspiration, and 90 per cent (27 of 30 patients) with incision and drainage. Two patients required hospital admission, for rehydration and intravenous antibiotics. The commonest organisms cultured were streptococci (62 per cent); 97 per cent of all patients responded to penicillin. This study indicates that most patients with peritonsillar abscess may successfully and safely be treated by permucosal needle aspiration, and oral penicillin, on an out-patient basis.

Neonatal stridor. Five-year experience at King Edward VIII Hospital, Durban

During the period January 1984-January 1989, 110 neonates were referred to the ENT clinic at King Edward VIII Hospital, Durban, with symptoms of upper airway obstruction. The medical records of these patients were reviewed in order to document the clinical presentation, diagnostic evaluation, pathological findings and therapeutic approach. All patients underwent a thorough clinical examination, postero-anterior and lateral chest radiography, soft-tissue lateral radiography of the neck and endoscopic evaluation. We outline our findings and briefly describe management. Of interest is the high incidence of vallecular cysts in this series (15%) compared with others.